Graves DISEASE was diagnosed in a woman who was in the 8th week of her second pregnancy. For the remainder of the pregnancy she was treated with 100 mg of propylthiouracil, 3 times a day, which was tapered to 100 mg twice a day for the last week of pregnancy. After 42 weeks' gestation, the woman gave birth to her first child, whose Apgar scores were 5 at 1 minute and 9 at 5 minutes. The infant was noted to have a hoarse cry, stridor, and dusky episodes. Results of physical examination were remarkable for a neck mass.
As congenital goiter was the presumed diagnosis based on the maternal ingestion of propylthiouracil during pregnancy, umbilical cord thyroxine levels were measured and found to be 95 nmol/L (7.4 μg/dL); at 36 hours the serum thyroxine level was 184 nmol/L (14.3 μg/dL; normal range, 5.4-10.9 μg/dL), and thyrotropin was 45 mU/L (normal